MEDICARE: MIKENNA R KLINGER PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6533	NV

General Provider Information

NPI Number	:	1083434922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKENNA R KLINGER PT

Provider Business Mailing Address
First Line	:	10614 MOUNT BLACKBURN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89166-5052
Country	:	US
Telephone Number	:	567-259-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	3841 W CHARLESTON BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1899
Country	:	US
Telephone Number	:	702-870-8060
Fax Number	:	702-870-4844

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2024
Last Update Date	:	10/22/2024

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Directions to “ MIKENNA R KLINGER PT” Practice Location

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